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59 BEAVER ST - BPA-13-66 ROOF --- fheC'onuno...... uf;blassachusel(s t Board of Building Regulations and Standards CI I'Y OF SALIi\1 ( tl �bl;tssachuseus Slate Building Code, 7SB CM1IR IL•ri..aJ Ihu Building Permit Application To Cbnslnnct. Repair. Renovate Or Demolish a One-or Tat o-k'umils' Du eRio.q This Section For OI'f 'ial Use Only Building Permit Number: D (e Applied: Ihtilding 011icial(Print N;une) Signature I)atc SECTION I:SITE INFORhIATION L I roperty Address: /^/-. 1.2 Assessors blip di Parcel Numbers — I.la Is this an accepted street?ves ✓ no Map Number I'urcul Number I.! Zoning Information: 1.4 Property Dimensions: Lining District Proposed Use Lint Area Isy 11) Frontage(11) 1.1 Building Setbacks(R) Frunt Yard Side Yards Rear Yard RcIluired Provided Re aired Provided Rcyuired Provided 1.6\Vxter Supply:IM.G.I.c.40.§!a) 1.7 Flood Zone Information: 1.8 Sewage Disposal System. I'tablic❑ Private O Zone: _ Outside Flood Lune? Municipal 0 On site disposal s)stein 0 Check il' esO SECTION ]: PROPERTY OWNERSHIP' v N;one(Print) City.slate,ZIP C!� Z28-Z Nu.and Stmet relephune Email Address SECTION!: DESCRIPTION OF PROPOSED WORKS(check all that apply) New Construction❑ Existing Building 0 Owner-Occupied 0 Repoirsls) 0 Alteratlon(s) ❑ Addition 0 Demolition ❑ Accessory Bldg. 0 Number of Units_ Other ❑ .Specily: Brief Description of Proposed Work-: u� /6Oc� f 2 A( r� �7�1 .r4r e J ,tc) a ! SECTION 4: ESTOIATED CONSTRUCTION COSTS licnl Estimated Costs: Official Use Only il.ahor and Mattriabl I. Building S I. Building Permit Fee: S Indicate how fee is determined: ❑Standard City:To++n Application Fee 2. Electrical S ❑Total Project Cost'i Item 6)x multiplier _ x 1. I'lunihimg S '. Other Fees: S_ J, >lcch.uaical Ill\ \('1 S List- j \lech.micdl I1:,re S ---------'-- �u .rcsipn l rota \Il Fees: S -------- Croak No. ('heck :\nnnmt C.tah -\nnnust: t. 1'ulal Project Cn+f ) a� g© � O PdiJ in Full O Oulsuulding Bul.uue Due: i SEX I ION 5: CONS I-RUctrION SERVICES -cuille ..... I ...V dhig 7 III)e"I�Jq cr I A CS I. 6 PC 04-V[IV 1010 .- I%PC MsVriplion J_Nt r_v_V I— it I Inrcsiricted 111... up(o 35 000 Vil 111 It Re,tricted M." slaiv./ill \1 Ma.qwl IW R,ii Ang x,lin OPI, WS ..dow.ind Sid, SF Solid Fuel Iltarning Appliances I Insulation Talc bona I muil addruza L) Mmolilion .1.2 Registered Mine Improvement Contractor(111C) IIIC RegiNtralion Numbvir F\Pirltittl 5419 I IIC Compan) Matto or I 11C litclil Njing —1 No. and Strait Email address City/Town,Strue,ZIP Telephone SECTION 61 WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 132. 1 ISC(6)) Workers Compensation Insurance aMdavit must be completed and submitted with this application. Failure to provide this atYIdavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes ..........a No...........(3 SECTION 7s:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner of the subject property,hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Print oNsiwr's Nuine(Electranic Signature) Date SECTION 7b: OWN ER' OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information I cot ned in this 0!pFlIcation is true act: rate IllTthe best of my knowledge and understanding. contained i this 16 Fr`,iiFo—,,nQr'.,i or At,Ih t)riNd Agent's Noma I I lV"ronic Sigiiattirv) Vila Nons: I. An Owner 7NOtuubiains a building permit to do his her own %Nurk,or an owner who hires an unregistered cuntraiVtor t (nut registered in the Hume Improvement Contractor I HIC) Program),will nu have have access to the arbitration registered program ur guaranty fund under M.G.L. c. 142.4. Other important information on the HIC Program can be flound at I Information on the Cunstruction Supervisor License can be found at 2. %\lien substantial N%ork is planned,pro%ide the infurninflun below! . I rotai flour area 1 j4. 11.) 1 including garage. finished basement attics.Jerks it purclu or Gross It%ing,Irea 154. 11 1 Habitable rouni count I IIQ,)I livalifig i-%iteill NtimhVrofdecki pordio I I,e vo Squorc I ootJcenia\ he QIllstilliNd t*klr I'otal IIrtJV6t 0,0"